Provider Demographics
NPI:1497461123
Name:FERNANDEZ BURGOS, LAURA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:FERNANDEZ BURGOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4504
Mailing Address - Country:US
Mailing Address - Phone:786-812-4353
Mailing Address - Fax:
Practice Address - Street 1:3137 DOWNING ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4504
Practice Address - Country:US
Practice Address - Phone:786-812-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty